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Saturday, August 28, 2010

Get confident, stupid!

I've now been an attending for less than two months and I've received all of the following comments*:

The latest was yesterday, when I asked one of my patients if she recognized me and she said, "Of course. You're that little one that everyone thinks looks like a student."

Great.

My usual response is, "I'm older than I look." Inevitably, the patient will then ask me how old I am because when you're either older than 80 or younger than 10, you can ask whatever the hell you want. My reply is, "I'm in my thirties and I have a child." That usually satisfies them.

Now don't get me wrong. I like being told that I look young. What woman doesn't? I mean, if it really bothered me, I'd stop yanking out those gray hairs, right? Sure, we sit around and complain about how "annoying" it is when patients tell us we look young, each trying to top one another with our stories. One of us will complain that a patient thought she was in college, another will complain a nurse thought she was a high school student, and another will say that at her last delivery, nobody could tell her apart from the newborn. We're all secretly flattered though, trust me.

I've also noticed that men don't complain nearly as much about being told they look young, possibly because the Doogie Howser comments actually bother them, not just fake bother them like us.

So in summary, I don't mind being told that I look young. (Or thin. That's okay too. Thanks, Woman With Hip Replacement.) But I am bothered by the lack of respect that seems to accompany some of these comments. When an inpatient I've been seeing for weeks calls me "kiddo," that makes me think I'm not being particularly respected.

I suspect it's a matter of confidence. Confidence makes you seem older. As a brand spankin' new attending at an unfamiliar hospital, my confidence is not super high and I'm not good at faking it.

I'm not sure what I can do to build my confidence. I see other physicians (usually men) who have less experience than me under their belts saunter into the room and act like they know it all. Do they truly think they know it all? Do they know more than I do?

And then I see other physicians, older ones, who are so effortlessly confident. They know the answer to every question I ask... or if they don't know the answer, they can tell me why there is no answer. I wonder if I'll ever be like those attendings and have that level of confidence and knowledge. Is it just a matter of time and experience? When does it happen?

My mentor does both of these things, and appears completely in control at all times, and like he knows everything about everything. As I've gotten to know him, I've realized this isn't the case -- it's just what he projects.

It's entirely possible that these things might make people think you're a) a know it all, and b) a bitch, but these names get thrown around all the time when women appear confident, even if they're neither a know it all or a bitch. I think we (women) are socialized to appear less confident because it's more likable and less intimidating. Isn't that lame?

Repeat to yourself: I am Fizzy and I am an ass-kicker. Grrr! You'll be projecting more confidence in no time.

I get comments on my age all the time. At the hospital where I volunteer, everyone thinks I'm a high school student until I mention something about one of my kids, then there is a collective dropping of the jaws. Looking young doesn't bother me, but I do think people take me less seriously when they assume I'm 15 and that can be a problem.

I suffered so long from that (what I think of as) Southern woman kiss-ass and constantly apologize for your every action in order to survive. That blows! I remember wearing my hair down deliberately in Autopsy Conference so my burning ears wouldn't show when I got stymied by a question.

I remember watching a male colleague, who is still my colleague on partner track with me in my group (and a good friend and consultant) prepare a fraction as much as me and come of smelling like a rose because of the image he managed to project to the attendings. I studied him letting attending's moods wash over him like water off a duck's back while I internalized it all and realized that he was moving through life much easier just by the way he approached it, much like Rock Star MD's mentor she mentioned above.

When I started my job three years ago, one of my partners who was going part-time said, "So I guess you feel like you're in the big leagues now." I replied quietly, maybe he didn't even hear me, "No, I feel like I am starting junior high all over again." Navigating a new world, with major responsibility, was scary as hell to me.

While I am much more confident now (and that did take time, more than a couple of months) I kind of enjoy being reminded every once in a while that I am human, and even we do make mistakes. It gives me the drive to dive into the books and discover that no matter how much I have trained and how well I am keeping up with CME, no one knows everything. By the nature of what we do, it is our responsibility to remain humble and retain our student status somewhat for the rest of our career.

I too love being told that I look young, thin, and even some patients say pretty. That won't happen forever, so I'll enjoy it while I can. I strive to find the balance between lack of confidence and the know-it-all bitch described above. I like to think I have, most days. It doesn't come easy, that's for sure.

Somehow, people find me intimidating. They say i exude confidence. I do not know how this happened. At one point I was just a pathetic high school grad who had no plan for college and got fired from countless jobs because I would stay up all night partying, and now I am an older medical student (probably your age fizzy) finally pursuing my dream with a husband and more than a few kids in tow. I am kind of a loser in a way (kind of a winner too). I think my confidence comes from the fact that if anyone tells me why I do not deserve to be here, I can tell them ten more reasons why I don't and yet I still am, so kiss my a$$.

Old MD Girl has good point about speech pattern. I mentor medical students in my private practice, and many female medical students have a pattern of ending every sentence, even declarative sentences, up in the air as though it's a question. Sounds more Valley Girl than professional. Then, when leaving the patient, instead of a firm handshake and "good bye", they say "good -luck". What's that - "good luck, hope your four vessel cabbage works out?"

I say good luck too. I like it better than good-bye. Even if I just looked at cancer under the scope and the patient has no clue (I leave the diagnosis handling to the doctor that has the treatment plan and that is not me - usually tell the patient it takes 24 hours to process the material) - I am still wishing them luck. A cancer diagnosis is not always the end of the world these days and I figure they will need it during their treatment.

Mothers in Medicine is a group blog by physician-mothers, writing about the unique challenges and joys of tending to two distinct patient populations, both of whom can be quite demanding. We are on call every. single. day.

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